Over
years or decades, chronic hepatitis B virus (HBV)
infection can lead to advanced liver disease including cirrhosis
and hepatocellular carcinoma (HCC).
Studies have shown that sustained HBV clearance reduces the risk of disease progression,
but it is unclear whether HBV DNA levels in patients with persistent viremia is
associated with disease severity. This is an important consideration, because
viral load could potentially be used to guide decisions about when to start treatment,
which is only required if liver disease is progressing.

In
the first study, C. Croagh and colleagues from Australia evaluated the prevalence
of significant fibrosis or cirrhosis and examined the relationship between serum
HBV DNA and alanine aminotransferase (ALT) levels, and liver inflammation and
fibrosis scores in chronic hepatitis B patients.

Liver
fibrosis was scored according to the Metavir system (fibrosis stages F0 through
F4; histological activity stages A0 through A3). Significant fibrosis was defined
as F2-F4 and significant inflammation as A2-A3.

Increasing baseline ALT level was associated with greater prevalence of significant
fibrosis and inflammation in both HBeAg positive and HBeAg negative patients.

"The
prevalence of significant fibrosis is highest in HBeAg negative patients with
viral load of > 25,000, but is not insignificant in HBeAg negative patients
with lower levels of viremia," the investigators concluded.

Among the 217 participants younger than 35 with ALT > 0.5 x ULN, 28% had liver
stiffness suggestive of insignificant fibrosis and 37% had advanced fibrosis.

Based
on these findings, the researchers concluded, "Risk of advanced liver fibrosis
increased in HBeAg positive patients aged over 35 years with ALT > 0.5x ULN,"
but did not correlate with higher HBV viral load.